Characterizing Disability and MRI Outcomes in Latinx People with Multiple Sclerosis Before and After the COVID-19 Pandemic
Carrie Hersh1, Mengke Du2, Sarah Worley2, Daniel Ontaneda3, Farren Briggs4, Devon Conway3
1Cleveland Clinic Lou Ruvo Center for Brain Health, 2Cleveland Clinic Department of Biostatistics, 3Cleveland Clinic Mellen Center for MS Treatment and Research, 4University of Miami Miller School of Medicine
Objective:
To assess the impact of the COVID-19 pandemic on disability and MRI activity in US Latinx people with multiple sclerosis (PwMS) and how that impact differed from other racial/ethnic groups.
Background:
COVID-19 was disruptive for PwMS and more severely impacted US racial/ethnic minorities.
Design/Methods:
Analysis included PwMS who self-identified as Latinx, Non-Hispanic Black (NHB), or Non-Hispanic White (NHW) in the Multiple Sclerosis Partners Advancing Technology and Health Solutions US sites with ≥1 visit within 1 year prior to March 2020 (pre-COVID), between March 2020-February 2021 (during COVID), and between March 2021-February 2022 (post-COVID [peak]). Performance outcomes included Patient Determined Disease Steps (PDDS), Walking Speed Test (WST), Manual Dexterity Test (MDT), and Processing Speed Test (PST). MRI activity was defined as new T2/gadolinium enhancing (GdE) lesions. Linear mixed-effects models assessed the impact of the periods on disability and MRI measures in Latinx PwMS, adjusting for age, disease duration, MS phenotype, and smoking status. The same models were applied across all groups, adjusting for race. Outcomes were compared between racial/ethnic groups.
Results:
There were 589 Latinx, 1,422 NHB, and 8,446 NHW PwMS in the study. Baseline characteristics in Latinx, NHB, and NHW were, respectively: female- 75%, 80%, 73%; median [IQR] age of diagnosis- 31 [24-39], 34 [27-42], 36 [29-44] years; relapsing-remitting- 40%, 37%, 42%; current smoker- 13%, 14%, 16%. In Latinx PwMS, MDT (dominant) worsened post-pandemic (p<0.001); PST worsened during the pandemic (p=0.02); WST worsened post-pandemic (p=0.03) compared to the pre-pandemic period. Latinx PwMS had worse MDT, WST, and PST vs NHW (all p<0.001) and better performance measures vs NHB (MDT and WST, p<0.001; PST, p=0.02). There was no significant worsening in PDDS or MRI activity in Latinx PwMS across time periods.
Conclusions:
Latinx PwMS had worsened disability measures over the pre- to post-pandemic period and demonstrated greater disability worsening than NHW but less than NHB.
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